MBBS OSCE · Emergency & Toxicology
OSCE — Iron Overdose
Eight-minute OSCE station on Iron Overdose: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Iron Overdose.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1]
Clinical context
From 1983 to 1991 iron caused over 30% of deaths from accidental ingestion of drug products by children; adult ferrous-salt (often prenatal) tablets remain the typical paediatric source, and intentional overdose is a recognised form of self-harm. Free iron is corrosive to gastrointestinal mucosa and, once binding capacity is exceeded, generates reactive oxygen species, uncouples oxidative phosphorylation, and produces metabolic acidosis, periportal hepatic necrosis, coagulopathy and shock. Elemental-iron triage: gastrointestinal effects from about 20 mg/kg; refer at 40 mg/kg (adult ferrous salts); systemic toxicity possible from at least 60 mg/kg. Course: early GI injury, a deceptive quiet interval, then systemic toxicity, then late gastric scarring. Diagnose with serum iron at least 4 hours after ingestion. Treat with crystalloid, whole bowel irrigation (not charcoal), and IV desferrioxamine 15 mg/kg/h when serious symptoms or iron over 500 microgram/dL within 8 hours are present.[1][2]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).[1]
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Vomiting, haematemesis and abdominal pain after iron tablet ingestion (stage 1) |
| Safety | Apparent clinical improvement in the quiet interval — DECEPTIVE; use serum iron and acidosis, not appearance |
| Safety | Shock + metabolic acidosis + hepatic failure after the quiet interval — chelate and ICU |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1][2]
References2ShowHide
- [1]Manoguerra AS, Erdman AR, Booze LL, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila), 2005.PMID 16255338
- [2]Baranwal AK, Singhi SC. Acute iron poisoning: management guidelines. Indian Pediatr, 2003.PMID 12824662